Loading...
HomeMy WebLinkAboutUntitled (2883) • MASON COUNTYn. 415 N 6TH STREET, SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 j Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 ODELL CHARLES K & LAURA B 4197 MATTSON PL NE BAINBRIDGE ISLAND, WA 98110 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL 2023-00064 0 340 E Eckert Rd 121081390013 The 2-party water system, Odell 2-Party (121081390013/121081390012), has been reviewed and is hereby APPROVED for 2 connections. Please continue to follow best management practices with maintaining your water system including regular water analysis, landscaping, keeping wellhead area free of contaminants, and stormwater management around the water source. If you have any questions, please contact me at 360-427-9670 Ext.353 or email at danderson@masoncountywa.gov Sincerely, David Anderson Environmental Health Specialist Mason County Environmental Health z n MASON COUNTY Date Received COMMUNITY SERVICES Amount F51, Received }Lowe./ Budding.Planning,Environmental Health,Community Health ..� 415 N.6th Street,(Bldg 8)-Shelton,WA 98584 WE L '. 0 I:"5 - (v 4 Shelton: 360-427-9670 x400 Belfair:360-275-4467 x400 Elms:360-482-5269 x400 �O TWO-PARTY PRIVATE WATER SYSTEM APPLICATION APPLICANT PHONE Charles Odell 206- 94( 9 -- q-7111 MAILING ADDRESS-STREET,CITY,STATE,ZIP '-t I 1177 S on) Pt /11 t3A//20a C /Se-An o wA /o SITE ADDRESS-STREET,CITY,STATE,ZIP 340 E Eckert Rd, Grapeview, WA 98546 PRIMARY PARCEL NUMBER(WELL SITE) 121081390013 SECONDARY PARCEL NUMBER(IF APPLICABLE) 121081390012 WATER SOURCE SOURCE TYPE PARCEL 1 LOT SIZE PARCEL 2 LOT SIZE E New ❑ Existing ® Well ❑ Spring 1 1 PROPOSED WATER SYSTEM NAME(REQUIRED) Q d ei / Z _ fA('-ty PROJECT DESCRIPTION DIRECTIONS TO SITE/CONDITIONS Site on Right 550' after stretch island bridge. Site Plan: (may also be attached) (property boundaries, structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,easements,etc...) • • DEC 9 2023 '. By— �a 1 \1103,moo, a�13 ` 0012' JAN032024 RECEIVED Submittals Checklist: (these additional items will be required for approval) • 141 Satisfactory Bacteriological sample (this may be deferred if well is not yet drilled) it Well Log with pump test or 4-hour capacity test performed by driller(this may be deferred if well is not yet drilled) r: Notice to Future Property Owners recording (record with Mason Co. Auditor, supply copy of recorded document) eptic Records (additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and available for public view on the Mason County Web site. Revised: 10/13/2021 Page 1 of 2 Staff Use Only Review Step 1: Well Site Inspection: YES NO NA ❑ [r ❑ Evidence of existing sources of contamination within 100 foot radius of water source? (drainfields, tanks, buildings; indicate distance on plot plan) 1 ❑ Cl Are there roads within the 100 foot radius of the water source? If so, is road rivate unty or State. What is distance to ROW? "'$0 K" ❑ ❑ Does the ground slope away from the water source site? (show slope on plot plan) Ij ❑ ❑ Is the well cap satisfactory? _ PII Screened and vented? Z ., ❑ The well casing extends above I and/concrete slab? (circle one) „,Withtel ❑ Is there evidence of a surface seal? Let 1`' 47.326 4'�120 Vogl � 0-0curl : —I Z t .8 JO g76 t Does the seal appear adequate? 1-14.5 : 8 P0. is 3 ❑ ❑ Is a variance necessary for well site approval? Comments ICI hear,( SU/rDu, 10 d 6 L', 1ev -t af- i a1. leaf_ 8 l� d . Tayr�'5 5v </ d5,it, a f 11�or Erne e- -4kiv7. Pass ❑ Fail Inspector _ Date /// Z 70 7i /let Review Step 2: Two-Party Review: YES NO NA X ❑ ❑ Water Well Report with adequate pump7tee�st on file? �,,r� 19 t�If NO, date of Capacity Test I I /f/I U Driller OG,('J Ara li, GPM ZO `�1� M) ❑ ❑ Received Satisfactory Bacteriological Analysis? Date of test 1 Z l I ✓ ❑ ❑ Received Signed, Notarized, and Recorded Notice? AFN Z Za6o I ❑ ❑ System appears adequate to serve 2 single-family residences based on information provided? Comments firea arovnd lAted1 Tot I ed fry/ Awn/ 1e1ei( 7/'/20Z Y Approved Cl Denied Reviewer Date 7l (3/ ? Z c'( Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made, express or implied of the future success or failure of this system. Well site approval does not constitute water system approval. {Pater System approval is a two-par!process. All proposed connections to new wells are subject to water adequacy requirements at time of building permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19rh, 2018 per ESSB 6091. Revised: 10/13/2021 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 WATER WELL REPORT ,)EPARTMENT OF Notice of Intent No. WE54384 ECOLOGY Unique Ecology Well ID Tag No. epa t J 3 Type of Work: gilli State of Washington O Construction Site Well Name(if more than one well): ❑ Decommission ey Original installation NO1 No. Water Right Permit/Certificate No. Proposed Use: ©Domestic 0 Industrial ❑Municipal Property Owner Name Charles Odell Dewatcring 0 Irrigation ❑Test Well ❑Other Well Street Address 340 E Eckert Rd Construction Type: Method: C New well 0 Alteration 0 Driven ❑Jetted N Cable Tool City Grapeview County Mason C Deepening ❑Other ❑Dug ❑Air- ❑Mud-Rotary Tax Parcel No. 121081390013 Dimensions: Diameter of boring 6 in.,to 110 ft. Was a variance approved for this well? ❑Yes ❑No Depth of completed well 110 ft. Construction Details: Wall If yes,what was the variance for? Casing Liner Diameter From To Thickness Steel PVC Welded Thread O I ❑ 6 in. +1 105 114 in. ❑ I 0 .❑ I ❑ Location(see instructions on page 2): 0 WWM or 0 EWM DIO in. in. O I ❑ ❑ I D SW /_/,of the NE h:Section 8 Township 21N Range 1W ❑ I ❑ in. _ in. D I ❑ ❑ I ❑ ❑ I ❑ in. in. ❑ I ❑ DID Latitude(Example:47.12345)47.326458 Longitude(Example:-120.12345) -122.830913 Perforations: ❑Yes 0 No Type of perforator used No.of perforations Size of pertixations in.by in. Driller's Log/Construction or Decommission Procedure Perforated from R.to It below ground surface Formation:Describe by color,character,size of material and structure,and the kind and nature of the material in each layer penetrated,with at least one entry for each change of Screens: Al Yes ❑No ❑a K-Packer ' > Depth 102.5 ft. information. Use additional sheets if necessary. Manufacturer's Name Johnson Material From To Type stainles Model No. Diameter in. Slot size 12 in.from 105 ft.to 110 R. Topsoil 0 10 Diameter in. Slot sizc in.from ft.to R. Blue clay 10 60 Brown sand 60 84 Sand/Filter pack:❑Yes ❑No Size of pack material in Blue clay 84 90 Materials placed from ft.to ft. Blue clay with gravel 90 95 Surface Seal: Al Yes ❑No To what depth?18 R. Peat 95 102 Material used in seal bentonite Did any strata contain unusable water? U Yes U No Green sand&gravel 102 104 Type of water'! Depth of strata Brown sand&gravel water bearing 104 110 Method of scaling strata off Pump: Manufacturer's Name Type:sub t I.P. 3/4 Pump intake depth:80 ft. Designed flow rate: 15 gpm Water Levels: Land-surface elevation above mean sea level ft. Stick-up of top of well casing ft.above ground surface Static water level 40 ft.below top of well casing Date Artesian pressure lbs.per square inch Date j Artesian water is controlled by (cap,valve,etc.) Well Tests: Was a pumping test performed? ❑No ❑Ycs ' ) by whom? Yield gpm with_ft.drawdown after hrs. Yield gpm with ft.drawdown after hrs. Yield gpm with R.drawdown after hrs. Recovery data(time=zero when pump is turned off—water level measured from well top to water level) Time Water Level Time Water Level Time Water Level Date of pumping test Bailer test 20 gpm with 17 tl.drawdown atler R 2 hrs.} Air test gpm with stem set at .for hrs. Date__ _ Artesian flow gpnt Temperature of water 'F Was a chemical analysis made? ❑Yes El No Start Date 11/1/23 Completed Date 12/2/23 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. O Driller 0 Trainee 0 PE-Print Name Mike Davis Drilling Company Davis Drilling Signature Address 340 NE Davis Farm RD License No.04(-7171/n City,State,Zip Belfair,WA 98528 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.DAVISDI1100A Date DEC 2023 ECY 050-1-20(Rev 08/I9)/f you need this document in an alternate format,please call the Water Resources Program at 360-407-6872. Persons with(rearing loss can call 711 Jar Washington Relay Service. Persons with a.speech disability can call 877-833-6341. Davis Drilling 340 NE Davis Farm Rd Belfair, WA 98528 Test Pump for: Charles Odell Address: 340 E Eckert Rd Grapeview, WA Well depth: 110' Pump size: 3/4 hp Static water level:40' Date: 12/28/23 TIME WATER LEVEL GPM 5m 58' 20 15m 60' 20 30m 60' 20 1h 60' 20 2h 60' 20 RECOVERY 1m 47' 3m 42' 4m 41' 5m 40' I 4 I I 4 26276 Twelve r Trees Ln NW '' Ste.0 'I SPECTRA Laboratories Kitsap Poulsbo,WA • ,.,Where eyurtence ma furl 98370 (360)779-5141 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County �� �//A/ '�J"J Collected t/�[1/RA �/� rA7nth Doy Yea D FL! V r/�nlSV�( Y., �V/ 2 Type of Water System(check only one box) - ✓44 0 Group A ❑Group B L4-1 OtherP e B Group A and Group B Systems—Provide from Water Facilities Inventory(WFI). RkcCF/L e04 ID# kb System Name: I ‹ ' 1 \< \p Contact Person: Day Phone: Cell Phone: Emai: Eve.Phone: Send results f0:(Print tL name,address and zip cods or email above tor electronic copy of results) (j/A(S �t 1,lYr/,J// F`CA r SAMPLE INFORMATION Sample collected by(name): ,f ( u/- 1.1 . Specific location where sampl etc oilected: Special instructions or comments: Type of Sample(check only one box) 1.❑Routine Distribution Sample(AIP) 2 ❑ Repeat Sample(AT) Chlorinated:Yes ❑ No❑ (from dir rtution system ale,unsat.routine) Unsatisfactory routine lab number. Chlorine Residual:Total_ Free____ 3.Ground Water Rule Source Sample Unsatisfactory routine collect date: S I 1 1 / Chlorinated:Yes___No 0 Triggered(NP) Chlorine Residual:Total Free 0 Assessment(NP) 4.Surface or GWI Raw Source Water Sample(Enumeration) ISI I I ❑ E.coil 0 Fecal Filleted Yes_no_ 5.)K,Sampte Collecled for Information Only: LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY 0 Unsatisfactory Total Caiform Present and Satisfactory ,, ❑E.crX present 0 E.coliabsent Bacterial Density Resuhs:Total Coliform mpn/100m1 E.cok!_____mpn/100ml. Fecal Colifomi _._ cfu/100m1. HPC cfu/1m1. Replacement Sample Required: 0 TNTC 0 Sample too old 0 Sample Volume 0 Damaged Container 0 me Lab Re recency umber ortrartyed: 11 S1_02 Receipt Tempp C': Method Coder='• r t 1 M922�fir1-COUNT/SM9222D (� Y 1bo.per.Oasadeatb bemoans amnorovrcmt. Dale In: Dag^ry. J 702J o r. rdu m olibltreiel AM Ow mama a oc ey..dMitt In DEC 2 U 2UT� Utz orw.pies.de,avi„mood ver ead DOH t.abSarnpie# 1 C Mot recess�.re uq o Me boo bssd end to serpn(e)s 010- �c 0 ynon YO be MYDaelas Ris typal dot ml be rrpodvsd wept I .. ____ oSi uoo;;l fev. eaa 0.50 opco dDf 5M1e Lebar.Wbe. DOH farm 431.319(01106.05l17) 2206085 MASON CO WA Return To GE ODELL�*193841 Rec P Fee�T$204 50 Pages. 2 Charles Odell I f1VVII R Dl O011 llnhl 1liii!lli Uii I11I III IIVu 11111111 III iill 1WI H 191 M, TT500 Pt-- NE 3R1 NR�1 0 E; )st,-AnJD, k) A q$11O Grantor(s): (1) Charles Odell , (2) L a v r o, 3 . O d e.f Grantee(s): (1)PUBLIC Legal Description (1)TR 1-C OF GOUT LOT 7 LOT:3 OF SP#2315 AF#569820,S-8,T-21N,R-1W (Abbreviated form:i.e. lot, block,plat or section, township, range) Assessor's Tax Parcel: (1) 12108-13-90013 NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (We)the undersigned grantor(s), certify that the water source located on the above- described real estate under Legal Description (1)and Assessors Tax Parcel(1)situated in Mason County, State of Washington, has been designated to serve a source of water to the following parcels situated in Mason County, State of Washington; herein described: Tax Parcel: (Connection 1) 12108-13-90013 Tax Parcel: (Connection 2) 12108-13-90012 The system owner is responsible for keeping this system in compliance. The name of the water system is: 0401 I. 2, - �nrt This system is designed to provide for two service connections. Planning and design approvals must be obtained from the department prior to expanding beyond this number of services.Additionally, a water right, obtained from the Department of Ecology, is required if the water system exceeds exemption standards. This system (has!has not) been granted one or more waivers from specific provisions of the regulations. Dated on this I% day of DEC 1,,ifrl , 20 2-3. Signature of Grantor(s): (1) L evac 4 i. Data.! , (2) { age 1 of 2 State of Washington ) County of Mason ) I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this 1 9 day of - ) YX x-, 20 3'J , (j irles CA-P ( I uurkA Ode/,OrsonalIy appeared before me,who is known to be signer of the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and year last above written. No ary Public 1p and for the State of Washington, residing at i,t Q.Att �t- My commission ekpires: (p-) -i -,)-5" P ..Cq..,, �+'' .. ,„,f 4 '/i O.,..- !V j 21021 N- i N.4 , AVs 0.�' s 2 // 9,;''aa 13-2 ,C� //"I1h WASN\�.`�r, Page 2 of 2